1169 Hypersomnia in an Adolescent Following COVID-19 Infections

Abstract Introduction The International COVID-19 Sleep Study found a 2 to 3-fold increase in hypersomnolence in persons reporting COVID-19 infection. Although the pathophysiology of COVID-19-associated hypersomnolence is still unclear, a para-infectious pathogenesis has been proposed, similar to cases of post-influenza narcolepsy observed following the Spanish flu epidemic of 1918. Report of case(s) A 16-year-old male presented to neurology clinic with complaints of fatigue, anorexia and headaches. His parents reported the sudden onset of excessive daytime sleepiness and sleep attacks in September 2022, severely impacting his daytime functioning. His reported sleep duration was appropriate for his age, and sleep hygiene was adequate. He denied cataplexy and hallucinations, but was having sleep paralysis 1-2 times weekly. He had never been vaccinated against COVID-19, and had two confirmed COVID-19 infections in January and June of 2022. His laboratory evaluation showed no other infectious causes, nor evidence of thyroid dysfunction or other endocrine abnormalities. His brain MRI was unremarkable. In April 2023, he had an overnight polysomnography followed by a multiple sleep latency test. PSG total sleep time was 7 hours and 22 minutes, and sleep efficiency was 93.1%. His sleep latency was 5.3 minutes and REM latency was 99 minutes. His AHI was 1.9 events per hour and his SpO2 nadir was 89%. The mean sleep latency on his MSLT was reduced, at 4 minutes and 36 seconds, and there were no sleep-onset REM periods. At his sleep clinic evaluation in April 2023, his Epworth Sleepiness Scale (ESS) score was 22. He was started on Adderall, which caused severe mood changes and worsening anorexia. This was switched to Modafinil, with significant improvement in subjective sleepiness, and his ESS score was 3 at follow-up. Conclusion Untreated hypersomnia has been associated with behavioral problems, mood disturbances, depression, and impaired neurocognitive function especially in adolescents. Hypersomnia is also associated with long-term increased risk of cardiovascular, endocrine, and metabolic disorders. According to the World Health Organization, there have been over 700 million confirmed COVID-19 cases to date. Given the health implications of hypersomnia, the relationship between COVID-19 and CNS hypersomnia and its etiology needs further investigation. Support (if any)